Models of Buprenorphine Induction

Erik Gunderson, M.D.
Assistant Professor, Department of Psychiatry & Neurobehavioral Sciences and
Department of Medicine
University of Virginia School of Medicine

Buprenorphine induction is an important aspect of treatment initiation that is challenging for patients and clinicians. Physician concerns about induction pose a barrier for treatment adoption likely due to the logistics of patient assessment and monitoring, as well as concerns about potential precipitated withdrawal. Fortunately with experience, the induction barrier diminishes. In addition, various practice models of induction may facilitate induction and provide practice-based evidence to help guide the induction process.

This presentation examined models of induction including the standard office approach and unobserved "home" induction method. Induction procedures and data are reviewed from a specialty outpatient treatment program to help inform practice. The "home" induction treatment protocol from a NIDA-sponsored pilot study of observed vs. unobserved induction is reviewed. Office and unobserved approaches are compared and contrasted regarding effectiveness, resource utilization, potential patient and physician perspectives, safety, and limitations.